A candidate for gastric bypass surgery, Nichols, a caseworker for the state's Child Protective Services, can't get Texas' health insurance plan to cover the surgery. Her insurance considers the procedure an elective, she said.

Now desperate, Nichols has turned to an unlikely place to help pay for the surgery: an Internet loan.

And she's not alone. It's a new option growing in popularity for many morbidly obese adults — some of whom are getting into debt by self-financing their bariatric surgeries, which cost roughly $25,000.

Nichols has applied on numerous Web sites — carecredit.com and SurgeryLoans.com — for high-interest surgery loans. But with an annual salary of about $30,000, she's having a hard time getting approved for the total amount.

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"It's a sacrifice that I have to make," said Nichols, who lives in northwest Houston. "No one else can help me."

As obesity continues to compromise the lives of many adults — an estimated 26 percent in the U.S. and 29 percent in Texas are obese, according to the Centers for Disease Control and Prevention — gastric bypass surgeries are on the rise. It is a last-ditch effort to fighting obesity, a slow and silent killer.

Gastric bypass is a drastic surgical procedure that reduces stomach size, forcing a person to eat less. Experts say the procedure also eliminates other weight-related illnesses such as diabetes, sleep apnea, hypertension and heart disease. Citing myriad reasons — from the initial costs to the uncertainties of the long-term effects — some company-sponsored insurance plans refuse to cover the procedure.

And there are risks — complications from blood clots or infections, even death. But overall, the surgery has become more popular and widely accepted as TV celebrities such as the Today show's Al Roker and Star Jones, former co-host of The View, have the surgery.

"I look at obesity as a disease," said Dr. Hadar Spivak, a popular Houston bariatric surgeon who performs about 500 surgeries annually and has stopped dealing with insurance companies. He said nearly half of his patients now pay him with surgery loans.

"And it is frustrating when I have to tell patients that I can't help them," he said. "That we only accept cash."

William Encinosa is a senior economist at the federal Agency for Healthcare Research and Quality, which monitors the cost and quality of the U.S. health care system. He said there has been a steady increase of patients who finance their own surgeries. In 2006, for example, 9,400 patients nationwide paid for their surgery costs, up from 3,200 in 2000. But Encinosa said it is unclear how many of these patients paid the hospital bills with loans.

Rebecca Johnson suspects many people were forced to do what she did: Get a loan. Last year, the married Devers resident took one out for $18,300 from Capital One to pay Spivak to perform her successful gastric bypass. She has a five-year payment plan of $484 a month that totals $29,000. She and her husband earn a combined annual income of $65,000.

"We really wanted to buy a house, but until we pay this off, we can't," said Johnson, 43, a bank teller. "We felt like my health is more important than a house."

Johnson has gone from 232 pounds to 154.

"I totally feel so much better about myself — mentally and physically," she said. "It was the best thing I could have done for myself."

Texas has become a big market for bariatric surgery loans. The state is home to some of the "fattest cities" in America, according to Men's Fitness magazine's annual survey. This year was no exception. Five Texas cities made the top 10, including Houston.

The rate of obesity has tripled in the past 20 years, said Neil Hutcher, a Richmond, Va., surgeon and former president of the American Society for Metabolic & Bariatric Surgery.

"In Houston, you can't pick up a magazine or drive down the street without seeing a billboard for bariatric surgery," he said.

Marc Morgan, national manager at California-based SurgeryLoans.com, is well-aware of this. His Web site gets heavy Internet traffic from Texas, he said.

The loans are considered high risk because there is no collateral involved, he said. Loans can last for up to seven years, he said.

"If you elect never to make a payment on your loan, we've already paid the doctor and we can't come out and repossess your gastric bypass — that would be messy," Morgan said. "But we see the need for this, and we see the applicants coming to us when insurance denies them."

Nichols is hoping to be one of their customers.

"I see this as having a car payment," she said. "And my health is much more important than getting a new car."